doc_clotaire
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An AIDS patient under treatment with a nucleoside analog and a protease inhibitor comes to medical attention with complaints of leg weakness and incontinence. His vital signs are within normal limits. Physical examination reveals reduced strength in the lower extremities with accompanying mild spasticity. There is also diminished sensation in the feet and legs bilaterally. Lumbar puncture shows:
Opening pressure.....100 mm H20
Cell count................5 lymphocytes/mm3
Glucose...................48 mg/dL
Proteins, total..........33 mg/dL
Gamma globulin.......8% total protein
Additional laboratory investigations show normal hematologic parameters, vitamin B12 within normal values, and negative serology for syphilis. MRI of the head fails to reveal any focal abnormality. Which of the following is the most likely diagnosis?
A. AIDS dementia complex
B. CMV polyradiculopathy
C. Cryptococcal meningoencephalitis
D. Vacuolar (HIV) myelopathy
E. Zidovudine-related toxicity
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| monam84
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It sounds like CMV radiculopathy (cauda equina syndrome) but the CSF doesnt show any changes... hmm.. good question
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| rock
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d-vacuolar myelopathy
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| monam84
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What is vacuolar myelopathy?
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| new_n_lost
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D. Vacuolar (HIV) myelopathy
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| new_n_lost
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Vacuolar myelopathy is the most common chronic myelopathy associated with HIV infection. It occurs during the late stages of HIV infection, when CD4+ lymphocyte counts are very low, often in conjunction with AIDS dementia complex, peripheral neuropathies, and opportunistic central nervous system and peripheral nervous system infections or malignancies (eg, cytomegalovirus, progressive multifocal leukoencephalopathy, lymphoma).
- Patients have a history of slow progression, painless leg weakness, stiffness, sensory loss, imbalance, and sphincter dysfunction.
- Relapsing-remitting courses have also been described.
- Vacuolar myelopathy is often seen in conjunction with cognitive decline, distal limb pain, and numbness from peripheral neuropathy.
- Back pain is not a prominent feature.
- Arm function is usually normal except for advanced vacuolar myelopathy
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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these Pts have Normal Vit B 12 levels
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| doc_clotaire
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 GOOD EXPLANATION NnL
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